Chun Yeon Joo, Choi Myung-Gyu, Kim Hyung Hun, Cho Yu Kyung, Ku AeKyeong
Departments of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Departments of Nursing, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Neurogastroenterol Motil. 2015 Jul 30;21(3):390-7. doi: 10.5056/jnm14129.
BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) has been suggested to be responsible for 23-68% of globus cases. The impedance baseline (IB) acquired by 24-hour multichannel intraluminal impedance monitoring has been proven to represent esophageal mucosal integrity. We aimed to investigate whether the IB is helpful for evaluating globus patients.
Twenty-four-hour multichannel intraluminal impedance pH tracings (MII-pH) were evaluated in globus patients. Differences in the IB between the acid reflux, non-acid reflux, and no reflux groups were analyzed. Receiver operating characteristic (ROC) curves were obtained to determine the optimal measurement point from the lower esophageal sphincter (LES).
A total of 62 patients were analyzed. MII-pH showed that acid reflux, non-acid reflux, and no reflux were present in 13, 5, and 44 patients, respectively. The acid reflux group had a significantly lower IB than the other groups at a location 3 cm from the LES. ROC curve analysis revealed that placement at a position 3 cm from the LES resulted in moderate diagnostic accuracy (area under the curve = 0.88). When we set 2500 Ω as the cut-off value for acid reflux at a position 3 cm from the LES, the additional diagnostic yield for acid reflux was increased by 19.4% compared with that obtained by MII-pH.
IB is complementary to pH findings enabling identification of a subset of patients with co-existing acid reflux. Catheter place-ment at a location 3 cm from the LES and a cut-off value of 2500 Ω may be reasonable criteria for estimating acid reflux.
背景/目的：胃食管反流病（GERD）被认为是导致23%-68%癔球症病例的原因。24小时多通道腔内阻抗监测获得的阻抗基线（IB）已被证明可代表食管黏膜完整性。我们旨在研究IB是否有助于评估癔球症患者。
对癔球症患者进行24小时多通道腔内阻抗pH描记（MII-pH）评估。分析酸反流、非酸反流和无反流组之间IB的差异。绘制受试者工作特征（ROC）曲线以确定距食管下括约肌（LES）的最佳测量点。
共分析了62例患者。MII-pH显示，13例、5例和44例患者分别存在酸反流、非酸反流和无反流。在距LES 3 cm处，酸反流组的IB显著低于其他组。ROC曲线分析显示，在距LES 3 cm处进行测量具有中等诊断准确性（曲线下面积=0.88）。当我们将距LES 3 cm处酸反流的临界值设定为2500Ω时，与MII-pH相比，酸反流的额外诊断率提高了19.4%。
IB是对pH值结果的补充，能够识别存在酸反流的部分患者。将导管放置在距LES 3 cm处且临界值设定为2500Ω可能是评估酸反流的合理标准。
